ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: FR-PO224

Renal Efficacy and Safety of Canagliflozin by Baseline Medication Use: Results from the CANVAS Program

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Neuen, Brendon Lange, The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia
  • L Heerspink, Hiddo Jan, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
  • Neal, Bruce, The George Institute for Global Health, UNSW Sydney, Sydney, Australia
  • Matthews, David R., Endocrinology and Metabolism and Harris Manchester College, University of Oxford, Oxford, United Kingdom
  • de Zeeuw, Dick, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
  • Mahaffey, Kenneth W., Stanford University School of Medicine, Stanford, California, United States
  • Fulcher, Greg, Royal North Shore Hospital, Sydney, New South Wales, Australia
  • Shaw, Wayne, Janssen Research & Development, LLC, Raritan, New Jersey, United States
  • Oh, Richard, Janssen Research & Development, LLC, Raritan, New Jersey, United States
  • Li, Qiang, The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia
  • Perkovic, Vlado, The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia
  • Jardine, Meg J., The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia
Background

Canagliflozin is thought to confer renoprotection partly by enhancing natriuresis and intravascular volume status. We sought to assess the renal efficacy and safety of canagliflozin in patients using other medications that also alter sodium excretion or volume status.

Methods

The CANVAS Program randomized participants with type 2 diabetes at high cardiovascular risk to canagliflozin or placebo. Other treatments, including the use of renin-angiotensin system (RAS) blockade, loop and non-loop diuretics were managed by treating physicians. Hazards ratios (HR) and 95% confidence intervals (CI) were estimated with Cox regression models, with selected medication by baseline treatment interaction terms added to test for heterogeneity. The primary renal composite outcome was sustained 40% reduction in eGFR, end-stage kidney disease or renal death.

Results

Of 10,142 participants in the CANVAS Program, 8116 (80%) were receiving RAS blockade, 1308 (13%) received loop diuretics, and 3182 (31.4%) received non-loop diuretics at baseline. The effect of canagliflozin on the primary renal composite outcome (HR 0.60, 95% CI 0.47-0.77) was consistent irrespective of baseline use of RAS blockade or diuretics (all P-heterogeneity>0.10; Figure). There was no evidence that the risk of renal-related serious adverse events was elevated by background use of medications that influence natriuresis or volume status, although few of these events occurred (Figure).

Conclusion

Canagliflozin appears to reduce the risk of progression of kidney disease in patients with type 2 diabetes, irrespective of use of some medications that also affect natriuresis or volume status, without additional renal-related safety concerns.

Funding

  • Commercial Support